Healthcare Provider Details

I. General information

NPI: 1154207868
Provider Name (Legal Business Name): ECS OF BAY AREA NORTH OPTOMETRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 IGNACIO BLVD
NOVATO CA
94949-6085
US

IV. Provider business mailing address

111 E 4TH ST STE 440
ALTON IL
62002-6206
US

V. Phone/Fax

Practice location:
  • Phone: 618-462-9818
  • Fax:
Mailing address:
  • Phone: 618-462-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SARA WERRIES
Title or Position: SR. MANAGER MVC
Credential:
Phone: 972-370-5552